Matenda a 2 a shuga: mankhwalawa ndi mankhwala othandizira komanso mapiritsi

World Health Organisation yati matenda ashuga ndi vuto la mibadwo yonse ndi mayiko onse. Matenda a shuga ndi omwe amakhalanso wachitatu pazomwe zimayambitsa kufa pambuyo pa mtima ndi khansa.

Ambiri - pafupifupi 90% ya milandu yonse yomwe yadziwika, chifukwa cha mtundu wachiwiri wa matenda osokoneza bongo, omwe amalumikizidwa ndi insulin kukana (insensitivity). Kuchuluka kwa shuga m'magazi kumachitika chifukwa cha kuthekera kwa insulin yolumikizana ndi zolandilira ndikuyendetsa glucose mu cell.

Popeza, kuwonjezera pa kubadwa kwa makolo, kudya zakudya zamagetsi kumathandizira kuti pakhale matenda a shuga a 2 komanso zotsatira zake - kunenepa kwambiri, kulimbitsa thupi pang'ono, kumachitika kawirikawiri motsutsana ndi maziko a atherosclerosis ndi matenda oopsa, ndikofunikira kuchiza matenda a shuga a 2 osangokhala ndi mankhwala omwe mumalandira kuti muchepetse shuga. Koma ndikofunikira kusintha moyo wonse, momwe kudalirana kwa shuga, komanso thanzi, zimadalira.

Kodi matenda a shuga a 2 amatha bwanji?

Kwa mtundu wachiwiri wa matenda a shuga, mankhwalawa amachitidwa ndikuchepetsa shuga m'magazi, pomwe kuli kofunikira kuwunikira osati zambiri zomwe zikuwoneka ngati kukhazikika kwawo kwakanthawi. Mwa izi, chizindikiro cha hemoglobin wa glycated chimagwiritsidwa ntchito.

Pochepetsa ndi 1%, ndizotheka kuchepetsa zovuta za matenda ashuga mwanjira ya nephropathy ndi retinopathy ndi 35-38%. Kuyang'anira shuga ndi kuthamanga kwa magazi kumalepheretsa kukula kwa matenda amitsempha, matenda a mtima, amachepetsa kuwonekera kwa zotumphukira mu mawonekedwe a phazi la matenda ashuga.

Zinthu zomwe zimasokoneza chithandizo cha mtundu 2 wa matenda a shuga ndi kutukuka kwake mwa anthu okhwima ndi okalamba omwe ali ndi zotumphukira zamitsempha, kuchepa kwa kayendedwe ka kagayidwe kachakudya ka thupi ndikuchepetsa zochitika zolimbitsa thupi.

Popeza matenda ashuga sangathe kuchiritsidwa, pulogalamu ya kasamalidwe ka shuga imapangidwa kwa wodwala aliyense. Zimathandiza kukhala ndi moyo wonse, kusunga thanzi komanso kupewa zovuta zoopsa.

Njira zazikulu zamankhwala zodwala matenda a shuga a 2 zimaphatikizaponso:

• Zakudya zamankhwala.
• Kuchepetsa kupsinjika.
• Zochita zolimbitsa thupi.
• Mankhwala.

Chithandizo cha mankhwala osokoneza bongo chimaphatikizapo mankhwala onse ochepetsa shuga piritsi, komanso gulu latsopanoli la insretomimetics, komanso insulini tikamaonetsa.

Njira zothandizira kubwezeretsa odwala matenda ashuga zimagwiritsidwa ntchito ngati muyezo wamankhwala; zimatha kusiyanasiyana pang'ono kutengera zaka ndi zomwe zimagwirizana ndi matenda. Koma kuti mupeze chitsogozo, ngati chithandizo chokwanira chikuchitika, ndikofunikira kuti muphunzire zomwe zikuwonetsa metabolism kuti muzitsatira magawo (manambala onse a mmol / l):

1. Kuthamanga kwa glycemia: magazi a venous (matenda a labotale) ochepera 6, m'magazi a capillary (kudziyang'anira nokha ndi glucometer kapena mawonekedwe oyesedwa) - osakwana 5.5.
2. Glycemia pambuyo maola 2 (magazi a venous ndi capillary) - ochepera 7.5.
3. Cholesterol chonse ndi chochepera 4.5
4. Lipoproteins: kachulukidwe kotsika - ochepera 2,5, okwera - kwa amuna oposa 1, komanso azimayi oposa 1.2.
5. Triglycerides: zosakwana 1.7.

Kuphatikiza apo, adokotala omwe amawerengera amawerengetsa kuchuluka kwa hemoglobin ya glycated - sayenera kupitirira 6.5% ndipo kuthamanga kwa magazi chifukwa chotsika kwa angiopathy sikuyenera kupitirira 130/80 mm Hg. Art.

Zakudya zamankhwala zamtundu wachiwiri wa shuga

Ndi onenepa kwambiri, chofunikira chakudya chimachepa. Kudya zakudya zopatsa mphamvu za calorie sikuyenera kupitirira 1800 kcal. Mu sabata muyenera kuchepetsa kulemera ndi 500 g - 1 kilogalamu.

Ngati chizindikirochi chili chotsika, ndiye kuti zikuwonetsedwa kuti kusinthana kwanyengo limodzi ndi sabata, nsomba, mkaka kapena masamba omwe amakhala ndi zopatsa mphamvu mpaka 1000 kcal. Mfundo zazikuluzikulu za zakudyazo ndikukana mafuta osavuta, opukusa chakudya komanso mafuta mafuta azinyama.

Chakudya chimakhala chovomerezeka pa nthawi yofananira, chakudya chambiri, kangapo 6 pa tsiku pazigawo zochepa. Kuchuluka kwa chakudya kotereku kumathandizira kuti thupi likhale lolimba komanso kuti shuga azikhazikika popanda kuchitika mwadzidzidzi, chifukwa, popeza wodwalayo adziwa za matenda ashuga, njira yodziwira odwala iyenera kuyang'aniridwa mosamalitsa.

Kuti muthane ndi vuto la matenda ashuga amtundu wa 2, muyenera kupatula kwathunthu zinthu zomwe zalembedwa:

• Zopangira: mikate yoyera, makeke, makeke amphika, maffini, ma cookie, ma waffle.
• Shuga, maswiti, zoteteza, ayisikilimu, koloko, mchere, uchi.
• Mpunga, semolina ndi pasitala
• Nyama yamafuta ndi Yopanda
• Nsomba zonona, zamchere komanso zosuta, zakudya zamzitini mu mafuta.
• Mphesa, mphesa zouma, zipatso, nthochi, nkhuyu, misuzi yazipatso zamafuta.

Shuga amasinthidwa ndi fructose, sorbitol, xylitol, aspartame, kapena stevia. Amakonzekera kuchepetsa mchere mpaka 3-5 g patsiku. Tiyenera kukumbukira kuti mu zopangidwa ndi zakudya zabwinobwino zimakhala pafupifupi 1 - 2 g. Ndi kuthamanga kwa magazi kapena ndi nephropathy, chakudya sichowonjezeredwa.

Pazakudya za mtundu 2 wa shuga, muyenera kukhala ndi zokupatsani zokwanira kuchokera kumizere yatsopano kapena yophika, kuchuluka kwathunthu kwa fiber sikuyenera kukhala kosakwana 40 g.W nthambi ikhoza kugwiritsidwa ntchito mu chakudya kuchepetsa index ya glycemic.

Zamasamba ziyenera kukhala zatsopano monga momwe mungathere masaladi ndi masamba amasamba. Muchepetse kaloti owiritsa, beets ndi mbatata.

Tsiku lililonse mapuloteni azikhala 0,8 -1 g pa kilogalamu ya kulemera kwa odwala. ndi kukula kwa matenda a impso, amachepetsa. Mapuloteni amakonda kupezeka kuchokera ku nsomba, zakudya zamafuta ochepa, nyama yotsika. Njira yabwino yophika ndikuphika, kuwaza ndi bwino osagwiritsa ntchito.

Monga magwero a vitamini, mutha kugwiritsa ntchito rosehip decoction, msuzi kapena chakumwa cha zipatso kuchokera ku cranberries, blueberries, blueberries, decoction ya chokeberry, mavitamini osonkhanitsa. M'nyengo yozizira ndi masika, multivitamini amasonyezedwa.

Kugwiritsa ntchito zolimbitsa thupi mu shuga

Kupanga malangizidwe pamalamulo olimbitsa thupi kumachitika poganizira zaka, kulimba, mkhalidwe wa wodwalayo. Kukhalapo kwa zovuta za matenda ashuga ndi matenda okhudzana ndi mawerengedwa.

Kwa odwala omwe ali ndi matenda a shuga a mtundu wachiwiri, kuchita masewera olimbitsa thupi ndi mtundu womwewo ndikulimbikitsidwa. Asanakhale makalasi, komanso pambuyo pawo, ndikofunikira kuyeza shuga, kuthamanga kwa magazi ndi kugunda kwa mtima.

Ngati shuga m'magazi ndi apamwamba kuposa 14 mmol / l, simungathe kuchita masewera olimbitsa thupi, chifukwa amatha kuwonjezera glycemia ndikuwonjezera ketoacidosis m'malo mochepetsa. Komanso, simungathe kuthana ndi shuga m'magazi otsika kuposa 5 mmol / L.

Kuti muwonjezere zochitika zatsiku ndi tsiku, ndikulimbikitsidwa:

1. Tsiku lililonse: kupaka magalimoto kapena poyendetsa pagalimoto zoyendera anthu kupita kumamita mazana atatu kupita ku 500, osagwiritsa ntchito kukweza, kuyenda galu, kuyenda kupita kumalo ogulitsira akutali, mankhwala kapena positi ofesi kuti muthe kuchita zambiri tsiku lililonse.
2. Kawiri pa mlungu, gwiritsani ntchito m'munda, muchotse, yoga, gofu kapena mawondo.
3. Katatu pa sabata: kuyenda, kuthamanga, kusambira, kuyendetsa njinga, kuvina.
4. Chepetsani kuwonera TV, kuwerenga kapena kuluka mpaka theka la ola, kenako ndikuchita zolimbitsa thupi.

Kuchita masewera olimbitsa thupi kumathandizira kuti shuga agwiritsidwe ntchito, ndipo izi zimachitika kwa maola angapo kumapeto kwa gawo, komanso zimachepetsa zomwe zili m'magazi a triglycerides m'magazi, zomwe zimayambitsa kuwonongeka kwa mtima, komanso zimachulukitsa lipoproteins yapamwamba. Zinthu izi zimachepetsa mwayi wa kuchuluka kwa mafuta m'thupi.

Kuchita kwa magazi kwa fibrinolytic kumachulukanso, mamvekedwe ake ndi kuphatikiza kwa maselo ambiri kumachepa, ndipo mulingo wa fibrinogen umachepa. Uku ndikothandiza kupewa matenda a thrombosis, kugunda kwa mtima komanso sitiroko.

Zowoneka bwino pamitsempha yamtima zili m'machitidwe otere:

• Kuthamanga kwa magazi kumachepa.
• Mu myocardium, kugwiritsa ntchito mpweya kumakulira.
• Neuromuscular conduction bwino.
• Kutulutsa kwamtima kumawonjezera.
• Kugunda kwa mtima kukukhazikika.

Kuphatikiza pa kukhudza minofu ndi minyewa yamthupi, zochitika zolimbitsa thupi zimapereka mphamvu yotsutsana ndi kupsinjika, kuchepetsa kuchuluka kwa adrenaline, cortisol, ndikuwonjezera kutulutsidwa kwa endorphins ndi testosterone.

Chofunikira kwambiri kwa odwala matenda ashuga ndikuti kugwiritsa ntchito ntchito zolimbitsa thupi kumatsitsa insulin kukana ndi hyperinsulinemia.

Mtundu wachiwiri wa mankhwala a shuga

Ndikotheka kukhala wathanzi ndimitundu yovuta ya shuga komanso m'magawo oyamba ndikudya komanso kumwa mankhwala azitsamba. Momwe mungapangire mankhwala ndi mulingo wa hemoglobin wa glycated wofanana kapena woposa 7%.

Mankhwala oyamba omwe angafotokozedwe kuti adziwe matenda a shuga ndi metformin. Zotsatira zake pakuchepetsa shuga m'magazi sizimasowetsa nkhokwe m'mimbayo, nthawi zambiri zimalekerera komanso sizimabweretsa mavuto.

Ubwino wofunikira ndikupezeka kwake komanso kusoweka kwa mphamvu. Chifukwa chake, magawo oyamba a chithandizo cha matenda ashuga, icho, limodzi ndi kuchepa thupi komanso kuwonjezereka zolimbitsa thupi, zimathandizira kukhazikika kwamagawo a glucose omwe ali mgawo lenileni.

Machitidwe a metformin pamagulu a shuga amawonetsedwa ndi zotulukapo:

1. Kuchulukitsa chidwi cha maselo a chiwindi kupita ku insulin, komwe kumachepetsa kupanga kwa shuga.
2. Kuphatikiza kwa Glycogen kumawonjezeka ndipo kuchepa kwake kumachepa.
3. Mu adipose ndi minofu minofu, kuyanjana kwa insulin receptors kumawonjezeka.
4. Kugwiritsidwa ntchito kwa glucose mu minofu kumawonjezeka.
5. Kumwazidwa kwa glucose m'matumbo kumachepetsedwa, komwe kumachepetsa kutuluka kwake m'magazi mutatha kudya.

Chifukwa chake, metformin sikuchepetsa kuchuluka kwa shuga, koma koposa zonse zimaletsa kuchuluka kwake. Kuphatikiza apo, amachepetsa triglycerides ndi cholesterol m'magazi, amachepetsa chiopsezo cha kuundana kwa magazi. Ili ndi malo ochepetsa chakudya.

Zotsatira zoyipa zimagwirizanitsidwa ndi kuchepa kwamphamvu kwa glucose m'matumbo ndipo zimatha kuchitika m'mimba, kutsekemera, ndi mseru. Izi zitha kugwiritsidwa ntchito ngati mugwiritsa ntchito milingo yoyamba yotsika ndikukula pang'onopang'ono.

Poyamba, 500 mg imayikidwa kamodzi kapena kawiri pa tsiku, ndipo mutatha masiku 5-7 kuti muwonjezere ngati pakufunika ku 850-1000 mg, muyenera kumwa mapiritsi mukatha kudya chakudya cham'mawa komanso mukatha kudya.

Kukonzekera kwa Sulfonylurea kumalimbikitsa kutulutsa insulin. Amakhala pama cell a beta m'masukulu a Langerhans. Amayamba kugwiritsidwa ntchito ndi mitundu yotsika kwambiri, ndikukula kamodzi pakadutsa masiku 5-7. Zopindulitsa ndizotsika mtengo komanso kuthamanga kwa kuchitapo kanthu. Zotsatira zoyipa - kuperewera kwa hyperinsulinemia, kunenepa kwambiri, pafupipafupi hypoglycemia. Mankhwalawa akuphatikizapo: Glibenclamide, Glimepiride, Gliclazide MV, Glycvidon.

Pofuna kupewa komanso kuchiza matenda a shuga a 2, mankhwalawa Acarbose (Glucobai) amagwiritsidwanso ntchito. Pansi pa kuchitapo kwake, chakudya chamafuta sichimamwa, koma chimatulutsidwa ndimatumbo. Chifukwa chake, chakudya chikatha palibe kulumpha kwakuthwa mu shuga. Mankhwala enieniwo samalowa m'magazi.

Acarbose sichikhudza insulin katulutsidwe, chifukwa chake, sichiyambitsa hypoglycemia. Zikondazo zimatsitsidwa. Kugwiritsa ntchito mankhwalawa kwa nthawi yayitali kumakhudza kagayidwe kazakudya:

• Kukana kwa insulin kumachepetsedwa.
• Amachepetsa kudya glycemia.
• Kuchepetsa kuchuluka kwa hemoglobin wa glycated.
• Amaletsa zovuta za matenda ashuga.

Kumwa mankhwala osokoneza bongo a acarbose amachepetsa mwayi wokhala ndi 37%. Poyamba, 50 mg imayikidwa madzulo pakudya chamadzulo, mlingo umakulitsidwa mpaka 100 mg katatu patsiku. Umboni wa odwala omwe adagwiritsa ntchito chida ichi akuwonetsa kusokonezeka m'matumbo, kumatulutsa, kupweteka m'matumbo ndikuwoneka bwino.

Magulu atsopano a mankhwala ochepetsa shuga

Glitazones - gulu latsopano la antidiabetic mankhwala limagwira ma receptors mu adipose ndi minofu minofu, kukulitsa chidwi chawo ku insulin. Kuchita izi kumachitika ndikuwonjezera kuchuluka kwa majini omwe amapanga mapuloteni pokonza shuga ndi mafuta acids.

Pankhaniyi, chiwindi, minofu ndi adipose minofu imatha shuga ochulukirapo m'magazi, komanso triglycerides ndi mafuta achilengedwe aulere. Mankhwalawa ndi monga rosiglitazone (Avandia, Roglit) ndi pioglitazone (Pioglar, Amalvia, Diab-standard, Pioglit).

Mankhwalawa amadziwikiratu chifukwa cholephera mtima, ndikuwonjezeka kwa ntchito ya chiwindi transaminase, mkaka wa m'mawere ndi pakati.

Kukonzekera kwa glitazone kuyenera kumwedwa mu 4 ndi 8 mg (wa roxiglitazone) ndi 30 mg patsiku la pioglitazone. Izi zimakuthandizani kuti muchepetse glycemia ndi glycated hemoglobin ndi 0,6 - 0,7%.

Mankhwalawa Repaglinide ndi Nateglinide amachita mwakuwonjezera kutulutsa kwa insulin, komwe kumakupatsani mwayi wowonjezera kuchuluka kwa shuga mutatha kudya. Amayesa maselo a beta potsegulira njira za calcium.

Zomwe zimandilonjeza kwambiri pamankhwala a matenda a shuga a mtundu wachiwiri ndi mankhwala atsopano - Baeta. Zochita zake zimawonetsedwa kudzera mumahomoni opangidwa m'matumbo am'mimba - ma insretins. Mothandizidwa ndi Baeta, kaphatikizidwe kamatumbo awa kamawonjezera, komwe kumakupatsani mwayi wobwezeretsa gawo loyambirira la insulin, kuti muchepetse kupanga kwa glucagon ndi acid acid.

Baeta imachepetsa kutsanulira kwam'mimba, potero kuchepetsa kudya. Zotsatira zake sizimadalira kuopsa kwa matenda ashuga. Mlingo woyambirira wa 5 mcg kawiri - ola limodzi musanadye chakudya cham'mawa komanso musanadye. Pakatha mwezi umodzi, mutha kuwonjezera mpaka 10 mcg.

Zotsatira zoyipa - mseru pang'ono, zizindikiro za matenda am'mimba, omwe nthawi zambiri amatha sabata yoyamba ya chithandizo.

Dipeptidyl peptidase - IV inhibitor, sitagliptin, anali womaliza mwa mapulani a incretin. Mankhwalawa amachitanso chimodzimodzi ndi Bayeta Koma pa enzyme ina, yolimbikitsa kapangidwe ka insulin poyankha pakudya zamafuta ambiri. Nthawi yomweyo, chizindikiro monga glucagon secretion imapanikizidwa.

Sitagliptin imagulitsidwa pansi pa dzina lamalonda Janouvia. Anaphatikizidwanso ndi metformin mu mankhwala a Yanumet, omwe amasintha mankhwalawa amtundu wa 2 shuga, popeza mankhwala osokoneza bongo oterewa amachepetsa shuga m'magazi mwachangu.

Pochita maphunziro azachipatala, zotsatirazi zidapezeka ndikugwiritsa ntchito Januvia:

1. Khola ndi kuonekera kuchepa kwa glycemia.
2. Kuchepa kwa kudumpha kwa shuga pambuyo pakudya.
3. Kuchepetsa kwakukulu kwa hemoglobin wa glycated.
4. Kutalika kwa kuchitapo kanthu, kuloleza kugwiritsa ntchito nthawi 1 patsiku
5. Kuchepa thupi.

Type 2 matenda a shuga a insulin

Chimodzi mwamaganizidwe olakwika a mtundu wachiwiri wa shuga ndi chakuti mtundu uwu ndi wopepuka ndipo sufuna chithandizo chachikulu. Wodwala akamvetsetsa kuti "Ndili ndi mtundu wachiwiri wa matenda ashuga," amakhala ndi lingaliro loti matenda ndi omwe amaphatikizapo chithandizo cha mapiritsi opanda insulin.

Mlingo wa glycemia panthawi yayitali matenda ashuga nthawi zambiri samatha kukhala ndi mapiritsi, chifukwa chake, pakudya zopanda ntchito komanso kuchuluka kwa mankhwala ochepetsa shuga, monga ngati glycated hemoglobin amaposa 7.5%, glucose yothamanga ndi apamwamba kuposa 8 mmol / l, index yamasamba ambiri kuposa 25 kg / m2 mankhwala a insulin akuwonetsedwa.

Chithandizo cha matenda a shuga 2 amtundu wa insulin amagwiritsidwa ntchito ketoacidosis, chithandizo cha opaleshoni, chitukuko cha matenda opatsirana ndimatenda a shuga mellitus mu mawonekedwe a neuropathy ndi matenda akulu a mtima. Kanemayo munkhaniyi ayankhula za zazikulu komanso chithandizo cha matenda ashuga.